Promoting Health and Wellbeing of Children and Families Through Relationship Based Interventions

Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. I aim to show how contemporary developmental science points us on a path to effective prevention, intervention, and treatment, with the aim of promoting healthy development and wellbeing of all children and families.

Thursday, September 10, 2015

Recent calls for screening for a range of mental
health problems point
to an important recognition of the need to identify and address emotional
suffering. Such screening offers an opportunity to decrease the stigma and
shame that often accompany emotional pain.

A
powerful new documentary The Dark Side of the Full Moon calls attention to
the under-recognition and under-treatment of postpartum depression. In one
scene, a mother refers to resistance from doctors who lack
resources to address positive screens as "ridiculous." She is
correct, if the alternative to screening is to look the other way in the face
of women who are suffering.

But she is highlighting a real dilemma.
For the value of screening lies in being able to listen to, and offer healing
for, the diverse range of struggles of individuals and families that fall
under the umbrella of postpartum depression, or other DSM defined mental
illness.

Recently a colleague spoke of her distress at
the lack of care available in her clinic where large numbers of women struggled
terribly in the early weeks and months of motherhood. “At least a doctor gets them started on a medication, but it’s a long wait for an appointment with a
therapist.”

In a primary care practice, for a teenage who
screens positive for depression, medication may similarly be the only option.

When a person feels alone and overwhelmed,
whether a socially isolated sleep-deprived mom with a fussy baby, a parent at a loss in the face of
an out-of-control preschooler who disrupts the whole family, or a teen struggling to make sense of a new
explosion of feelings that accompany this stage of separation and identify formation, an hour of listening, particularly with someone with whom we have a longstanding trusting relationship, can have great healing power.

Connectedness regulates our physiology and protects against the harmful effects of stress. Charles Darwin, in a work less well known but equally significant to the Origin of Species, addresses the evolution of the capacity to express emotion. He identifies the highly intricate system of facial muscles, and similarly complex systems of muscle modulating tone and rhythm, or prosody, of voice that exist only in humans. These biologically based capacities indicate that emotional engagement is central to our evolutionary success.

Screening is an essential first step in alleviating emotional suffering. However, universal screening for mental health disorders, in the absence of opportunity to listen to the full complexity of the experience of a child and family, may lead to massive increases in prescribing of psychiatric medication. Medication may have an important role to play, and may at times be lifesaving. However, as I argue in my forthcoming book, prescribing of medication in the absence of protected space and time for listening may actually interfere in development.

These recommendations for screening can be understood as a well-intentioned effort to bring attention to the troubled state of mental health care in our society. But as we move forward to address the vast scope of problems that we will uncover, we need to think very carefully. The value of listening cannot be underestimated.

the baby connects

About Me

I am a pediatrician and writer with a long-standing interest in addressing children’s mental health needs in a preventive model. I have practiced general and behavioral pediatrics for over 20 years, and currently specialize in early childhood mental health. I am the author of The Developmental Science of Early Childhood:Clinical Applications of Infant Mental Health Concepts from Infancy Through Adolescence" ( 2017)"The Silenced Child:From Labels, Medications, and Quick Fix Solutions to Listening, Growth, and Lifelong Resilience" ( 2016) "Keeping Your Child in Mind: Overcoming Tantrums, Defiance, and other Everyday Problems by Seeing the World Through Your Child's Eyes"(2011) " I am on the faculty of UMass Boston Infant-Parent Mental Health Program, William James College, the Brazelton Institute, and the Austen Riggs Center.